Remove cancer ‘label’ for low-risk conditions, argue researchers

Using the ‘c-word’ for some low-risk conditions prompts patients to seek surgery for tumours that are very unlikely to harm them, says an analysis published today in the BMJ.

August 13, 2018

The BMJ analysis, co-authored by academics from the University of Sydney, Bond University and the Mayo Clinic in the US, shows evidence is building that patients being told they have ‘cancer’ rather than ‘lesions’ or ‘abnormal cells’ will see patients opting for more invasive treatments then may be necessary to keep them safe.

Analysis lead Brooke Nickel of the University of Sydney said a prime example for removing the cancer label was for low-risk papillary thyroid cancer.

“Studies show that progression to clinical disease and tumour growth in patients with small papillary thyroid cancer who choose surgery are comparable to those who monitor their condition.”

Similarly, in localised prostate cancer where active surveillance has been a recommended management option for many years, studies show that internationally most men still prefer radical prostatectomy or radiation therapy.

Active surveillance involves closely watching a patient’s condition but avoiding treatment unless there are changes in test results that show the condition is getting worse.

Co-author Professor Kirsten McCaffery said while active surveillance was increasingly being recognised as a safe management option for some patients with cancer, there was still a strong belief that aggressive treatments were always needed.

The authors say cancer types that could be considered for re-naming include intrathyroidal papillary thyroid cancer (<1cm in size), low and intermediate grade ductal carcinoma in situ (DCIS), also often known as stage 0 breast cancer, and localised prostate cancer (Gleason ≤6).

Moves to remove the cancer label aren’t new, said the authors.

“An early example of this was when the World Health Organization and International Society of Urological Pathologists removed the cancer label from bladder tumours. In 1998, they agreed that a condition known to rarely progress to invasive cancer should not be called ‘cancer’”.

In this change, ‘papilloma and grade 1 carcinoma of the bladder’ were reclassified as ‘papillary urothelial neoplasia of low malignant potential’.

A similar change has been made in the labelling of cervical abnormalities detected during a Pap smear, which has supported more women to follow active surveillance in preference to invasive treatments.

“The evidence suggests to us that is time to stop telling people with a very low risk condition that they have ‘cancer’ if they are very unlikely to be harmed it,” said Dr Ray Moynihan, a Senior Research Fellow at Bond University.